ELECTRONIC VISIT VERIFICATION (EVV) · EVV is the electronic verification and documentation of...

Provider Training

ELECTRONIC VISIT VERIFICATION (EVV)

H8423_MCDTX_18_69242_PR Approved

EVV is the electronic verification and documentation of visit data, such as the date and

time the provider begins and ends the delivery of services, the attendant, the recipient,

and the location of services provided.

• Services that require EVV:

– Personal assistance services

– Personal care services

– PAS Protective Supervision

– In-home respite services

– Community First Choice - Personal assistance services and habilitation

Note: Consumer Directed (CDS) Service and Service Related Option (SRO) Providers

are optional.

Electronic Visit Verification (EVV)

2 Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2018 Cigna

– EVV works with the member’s home landline or an approved small alternative

device

– EVV is a telephone and computer-based system that verifies visits when services

has been rendered

– A small alternative device can be ordered from the vendor if a member does not

have landline or the member does not want the landline to be used

– HHSC approved vendors will provide training and technical support to the providers.

– EVV services are at no cost to the provider

How does EVV work?


– DataLogic (Vesta)

– All HHSC approved EVV vendors are directly contracted with Cigna-HealthSpring

(CHS) STAR+PLUS.

• EVV vendors and CHS should be notified of any system issues that last longer

than 48 hours.

• EVV vendors and CHS should be contacted immediately (within 48 hours) of

any EVV system issues that affect the ability of your attendant's or office staff to

use the system as expected.

DataLogic(Vesta) Software, Inc.

Phone: 1-844-880-2400

Fax: 1-956-412-1464

www.vestaevv.com

Which Vendor will provide EVV services?


http://www.vestaevv.com/

• Vendors are responsible for training providers on the use of their system.

• Vendors are responsible for providing technical support for their system. Contact

your vendor directly for training or support.

• Vendors must submit a monthly training list of Cigna-HealthSpring’s (CHS)

contracted providers to CHS.

• Vendors will not bill providers for the use of the equipment that is needed, their

service includes:

– Vendor provision of provider training

– Visit verification

– Customer assistance and support

– Interfacing

– Reporting

– Hardware (i.e. small alternative device)

– Software

– Any other additional costs the vendor will incur to perform all of the required

services and deliverables

Vendor Responsibilities


• EVV reporting is done primarily through your selected vendor.

• Vendor has an integrated reporting tool for providers to use.

• Any requests for EVV reports should be directed to your vendor.

• Vendor is required to provide you reports of transaction activity.

• Vendor is required to provide you access to the standard EVV reports created by the

Texas Health and Human Services Commission (HHSC).

• Each provider is responsible for ensuring that their vendor is submitting accurate

data to Cigna-HealthSpring on their behalf prior to submitting claims.

Vendor Reports


• Vendors will provide EVV data reports to providers upon request. Reports such as:

– EVV Visit Log

– Units of Service Summary Report

– Attendant Providing Services by Individual

– Provider Agency/Financial Management Services Agency (FMSA) List

– Contract List

– Alternate Device Order Status

– EVV Compliance Plan Summary

– EVV Compliance Plan Daily

– Reason Code Free Text

– Reason Code Use

– CDS Employee List

– Provider Compliance Alert Report

– Failed to Export Report

– Monthly Summary Reports

– Individual/Member Device Type Report

– Landline Phone Sampling Report

Vendor Reports, continued…


• Providers will verify times of service using the vendor’s specified process.

• Providers must ensure all visit maintenance is completed prior to submitting claims.

• Providers are responsible for ensuring all required data elements match prior to

submission and are uploaded or entered into the EVV system completely, accurately

and in a timely manner.

• Providers that do not correct missing, incomplete or inaccurate data will experience a

lockout of the system after 60 days from date of service. A system lockout will prevent

agencies from completing timely visit maintenance until all required data is entered into

the system. Providers will retain limited system access until all necessary data is

addressed to completion.

• Providers must submit a request to CHS with an explanation, including supporting

documentation in order to unlock visit maintenance past 60 days. CHS will review and

make a determination if the visit will be reimbursed.

Provider Responsibilities


• The following data elements must be entered accurately and completely in the EVV

system to identify:

– The provider agency: TIN (Taxpayer Identification Number)

– NPI (National Provider Identifier)

– API or TPI (if applicable)

– Provider legal name

– Provider address

– Provider city

– Provider ZIP

Provider Responsibilities, continued…


The following data elements must be entered accurately and completely in the EVV

system to identify, continued:

– The individual/member receiving services: Medicaid identification number

– First name

– Last name

– Date of birth

– Home telephone landline number(if applicable)

– Payor

– MCO HCPCS

– MCO modifier(s)

– MCO System Unique Member ID

– MCO Service Delivery Area of member's residence



The following data elements must be entered accurately and completely in the EVV

system to identify, continued:

– Employee providing services: Employee ID (Employer Assigned ID for HR/Payroll

purposes)

– Employee last four Social Security numbers or passport number

– Employee discipline (must be one of the following: attendant, nurse, CNA, PT, OT,

SLP, other)

– Employee first name

– Employee last name

– Employee start date (start date of employment with provider)

– Employee end date (end date of employment with provider) (if applicable)

– Additional data that is required, but will not result in system lock out. ◦Employee EVV

user ID (user ID used to conduct visit maintenance)

– Employee EVV user first name (EVV user name — first name of person associated

with EVV user ID)

– Employee EVV user last name (EVV user name — last name of person associated

with EVV user ID)



• Ensure that authorization for services is in place prior to providing services to the

member. Only authorized and verified units of service will be paid. Any unauthorized

and/or unverified units will be denied and/or recouped.

• To avoid denials and/or delay in payment, claims for multiple dates of service (DOS)

should be billed on a separate line for each day with the number of units per day.

• CHS “highly recommended” billing on separate lines for each day, with the number of

units per day. (this will allow the provider to know exactly which date/unit was recouped

versus bulk billing and researching the information).

• Split shifts hours should be added together as a single claim DOS.

• Unit amounts can be billed in full or partial amounts.

• Units amounts will change – effective 12/1/2018, from 1 unit = 1 hour to 15 minute

increments = 1 unit (Example: 4 units = 1 hour).

Claims Process for EVV


• If a claim fully denies:

– Review submitted data with your EVV vendor

– Review Failed to Export report from Vendor system

– Any changes to your data will need to be made by the provider agency into your

vendor system.

Note: Exception to the rule is, Visit Maintenance Unlock Request for scenarios outside

provider’s control - approval is at Cigna-HealthSpring’s discretion.

Claims Process for EVV, continued…


In order to unlock visit maintenance past 60 days, you must submit a request to CHS with

an explanation (include supporting documentation with your request). CHS will review

and make a determination.

Please send the completed form electronically from our website at:

http://starplus.cignahealthspring.com/evv

Click on the link ‘Electronic Visit Verification (EVV) Initiative Information’ on the

homepage to send a SECURE email to Cigna-HealthSpring Mailbox at

[email protected] with the following information:

• Provider Name Member Name

• Contact Number Medicaid ID

• NPI/TIN/Contract Number Dates you need to access

• EVV Vendor Name Explanation of why you need to unlock

Request to Unlock Visit Maintenance for Cigna-HealthSpring

(CHS)





mailto:[email protected]

• Providers must use an HHSC approved reason code on visit maintenance EVV

transactions.

– As of December 1, 2016 there are 28 reason codes in the HHSC approved EVV

systems.

– 23 Preferred Reason Codes

– Five Non-preferred Reason Codes

– Providers must associate the most appropriate reason code with each change made

in visit maintenance and enter any required free text in the comment field.

– All reason codes allow a provider agency to enter free text in the comment field;

however, eight reason codes require specific information be entered in the comment

field.

– If the provider agency does not enter the required free text with the specified

information, the visit is subject to recoupment or denial.

Please refer to HHSC for up-to-date list and definitions at:

https://hhs.texas.gov/sites/default/files//documents/doing-business-with-

hhs/providers/long-term-care/evv/hhsc-reason-code.pdf

EVV Reason Codes


https://hhs.texas.gov/sites/default/files/documents/doing-business-with-hhs/providers/long-term-care/evv/hhsc-reason-code.pdf

















• If Cigna-HealthSpring determines a provider agency has misused preferred reason

codes per policy, the provider agency compliance plan score may be negatively

impacted, and the provider agency may be subject to:

– Assessment of liquidated damages

– Imposition of contract actions

– Implementation of the corrective action plan process

– Referral for a fraud, waste, and abuse investigation

• For example, providers use a preferred reason code 100 when there is no call in or call

out. Providers can use the ‘Request to Unlock Visit Maintenance’ form available on our

CHS website at https://www.cigna.com/starplus/health-care-professionals/evv/

EVV Reason Codes, continued…


https://www.cigna.com/starplus/health-care-professionals/evv/





17

Payment Disputes

Payment Dispute Form

A payment dispute is a written communication (i.e. a letter) from the Provider about a disagreement with the

manner in which a claim was processed, but does not require a claim to be corrected and does not require

medical records.

The Payment Dispute Form is located on our website at:

https://www.cigna.com/static/docs/starplus/providers/payment-dispute-form.pdf

Examples of when to use the payment dispute form: (this is not a

complete list)

• Denial for “timely filing”, but provider has proof of timely

• Denial for “no authorization on file”, but provider has

authorization listed

• Denial for “misuse of EVV reason code(s)”

• Denial for “no coverage”, but member was active during the Date

of Service (DOS)

• Provider not being paid at correct reimbursement rate, paid

incorrectly

• Denial for incorrect modifier, CPT code, NPI/TIN/TPI, Place of

Service (POS), Date of Service (DOS), Diagnosis (DX) code,

etc. and denied incorrectly

• Denial for “no active provider contract” and provider does have

an active contract listed

• Denial for insufficient units, per authorization on file there’s units

available, or there’s no units available due to error on our end

• Denial for incorrect payment

Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2018 Cigna






• CHS will review all Electronic Visit Verification (EVV) claims and transactions submitted

with a dates of service April 1, 2016 and after. Any paid claims that do not have an

EVV associated transactions will be subject to recoupment.

• In addition, we want to reiterate, starting April 1, 2017 all providers must achieve a

quarterly compliance score of 90%. CHS will be closely monitoring the score and

assessing liquidated damages and corrective action plan for those providers that do

not meet the target.

• A separate letter will be mailed to providers detailing the claim overpayment and allow

you time to reply with additional documentation to support the claim submitted.

• Cigna-HealthSpring will compare EVV data retrospectively and recoup if there is not an

associated transaction for the date of service(s) and/or units, modifiers and HCPCS

codes billed that does not match.

Recoupment Process


• Providers who do not agree with Cigna-HealthSpring’s findings on the recoupment letter,

have 45 days to submit a check or request a review before we offset future claim

payments.

• You can find our forms on our website at: http://starplus.cignahealthspring.com/evv

EVV Recoupment Reconsideration

• EVV Review Request Form (Use only when you have verified visits to submit for

reconsideration.)

• EVV Visit Maintenance Unlock Request Form (Use only for dates of services listed on

your Request for Refund of Unverified Services letter - NOTE: approval is at MCO's

Discretion.)

For additional questions, contact our Provider Services Department at 1-877-653-0331,

Monday to Friday, 8 a.m. to 5 p.m. CT or email: [email protected]

Recoupment Process, continued…




https://www.cigna.com/static/docs/starplus/providers/starplus-evv-review-request-process.pdf

https://www.cigna.com/static/docs/starplus/providers/starplus-evv-maintenance-unlock-request.pdf


Q: I do not have a home landline. Do I need to get one to continue my services?

A: No, EVV does not require individuals/members to get a home landline phone. If you do

not have a home landline or you do not want your personal attendant to use your home

landline, a small alternative device will be ordered and installed in your home for your

personal attendant to use to clock in and out.

Q: I do not have a landline but I have a cell phone. Can my attendant use my personal

cell phone to call the EVV system?

A: No. The use of the individual's/member's personal cell phone is not allowed and your

attendant should never ask to use your cell phone to call in and out.

Note: The only exception to cell phone use is if you are a Consumer Directed Services

(CDS) employer.

Q: Can an individual/member receive services in the community with EVV?

A: Yes. The use of EVV does not change the way and location in which services are

delivered. Individuals /members will be allowed to receive services in accordance with

their service plan and existing program rules.

Frequently Asked Questions


Q: When will the contract for MEDsys expire?

A: HHSC is working in collaboration with MCOs, MEDsys and DataLogic to transition all

providers before the MEDsys contract expires on Nov. 6, 2018. The contract will not be

extended or renewed.

Q: What steps should I take for unsent transactions or transactions that have been

rejected by Cigna-HealthSpring?

A:

• Prior to submitting a claim to Cigna-HealthSpring (CHS), providers must review

DataLogic’s (Vesta) Failed to Export Report to identify rejected transactions

• If the report shows unsent or rejected transactions the provider must make the

applicable corrections, to ensure all data elements are correct and the transaction(s) is

submitted to the correct payer.

• Transactions can be rejected for multiple reasons.

• Before billing CHS, please verify and confirm all transactions associated to the claim

have been successfully transmitted to CHS.

• Failure to review the failed to export report and make applicable corrections prior to

submitting a claim to CHS may result in your claim being denied or recouped. For

training on how to use the Failed to Export Report, please contact Vesta at 1-844-880-

2400 or email them at [email protected]

:




Q:What is timeline for transitioning from MEDsys to DataLogic (Vesta) EVV system?

Please follow the steps listed below to initiate the vendor transition as soon as possible to

remain in compliance with EVV requirements:

1. Initiate the transition process with DataLogic by completing the Vesta EVV Agency

Information form.

2. Submit the form to DataLogic today by email or fax to 956-412- 1464.

3. DataLogic will contact the provider agency representative to begin transition activities

and initiate data transfer from MEDsys.

Your agency must begin logging EVV visits using the DataLogic Vesta EVV system by

Sept. 30, 2018. The last day to retrieve visit reports or perform any visit maintenance

within the MEDsys EVV system will be Oct. 28, 2018.

Once your agency has submitted the Vesta EVV Agency Information form, your agency

can begin training on the DataLogic EVV system. For more information on DataLogic

Vesta training opportunities, visit the training schedule on the Vesta website.

You may contact DataLogic Vesta at [email protected].

Q: What happens if a Provider fails to transition to the DataLogic system?

A: Providers who do not transition to the Vesta EVV system on or before Sept. 30, 2018

may be unable to record EVV visits for transmission to payers. Providers who submit

claims without EVV visits may have claims denied or recouped by payers.




Q: What telephone service types are approved for EVV use?

A: Wired phone connected to a phone jack in the wall.

• Non-wired phone with base connected to a phone jack in the wall (i.e., cordless phone)

• Home telephone service where the phone cannot be disconnected and used at a

different address/location. This includes phone service through the local:

• Cable Internet Provider (e.g., Time Warner, Comcast, AT&T, etc.), and

• Digital Voice via Verizon’s FiOS (Fiber Optic Service).

Q: How should claims be filed that have multiple dates of service?

A:

Frequently Asked Questions, continued…


For example: if billing DOS 01/01/2017 to 01/15/2017, bill each date of service on (DOS) a

separate line. The DOS 01/01/2017 on the first line, DOS 01/02/2017 on the second line, DOS

01/03/2017 on the third line, etc..

All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation, including HealthSpring

Life & Health Insurance Company, Inc. The Cigna name, logos, and other Cigna marks are owned by Cigna Intellectual Property, Inc. Cigna-

HealthSpring CarePlan is a health plan that contracts with both Medicare and Texas Medicaid to provide benefits of both programs to

enrollees. © 2018 Cigna

Thank you for reviewing the Cigna-HealthSpring Electronic Visit Verification

Training.

If you are ready to take the quiz and acknowledge completion click

CONTINUE.

If you would like to review the training again prior to taking the quiz, then

review the presentation again from the beginning slide.

https://cigna-healthspring.articulate-online.com/3235466197

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